Scheduling Information Form

Schedule Your Initial Appointment

Thank you for your interest in scheduling an appointment with UAF Legacy Health! We are scheduling appointments with Dr. Matt Bryan, Dr. Susana Keeshin and Nurse Practioner, Sally Bowen. Please complete the following information and a Patient Care Coordinator will contact you by phone to schedule your appoitment.
Exisiting Patients Please Call (801) 823-1988

Schedule an appointment through your patient portal. If you require assistnace navigating your patient portal please call.
Name*

First NameLast Name
E-mail
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Phone Number*

Area CodePhone Number
Preferred Provider*
Insurance Carrier*
Insurance Plan
Please provide insurance plan if known
Insurance Plan
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Schedule Your Initial Appointment